FROM COOLING VESTS to bee-sting therapy, individuals continually look
to alternative treatments to ease their MS symptoms. Yet no data from welldesigned,
controlled, large-scale trials exist to gauge the efficacy and safety of
most of these therapies.

This is true of marijuana and other hemp derivatives. There are small
studies and anecdotal reports aiming these substances improve some MS symptoms,
such as spasticity and tremor. A new study, reported at the recent Sixth
Congress of the European Federation of Neurological Societies, discounted
the use of cannabis to treat MS tremor. Although based on a small sample,
the report concluded that as shown by objective outcome measures cannabis
use doesn't improve tremor in individuals with MS.

The double-blind, randomized, controlled, crossover trial consisted
of 14 individuals with upper-limb-action tremors (6 men and 8 women, aged
35 to 46 years). All study subjects were recruited from the general neurology
outpatient clinics at Derriford Hospital, Plymouth, and the Royal Cornwall
Hospital, Truro, both in England. The lead investigator was Patrick Fox,
MD, research registrar in neurology at the University of Plymouth.

The mean score on the 0-10 Expanded Disability Status Scale (EDSS) for
these individuals was 6.25 (range 3.5 to 7.5). With a score of 6.0 or higher,
people need an assistive device for walking. No subject had used cannabis
within the past 30 days. Patients who answered yes to a history of psychotic
illness or ischemic heart disease were excluded from the trial.

Study participants received either placebo or Cannador (Weleda International),
a cannabis extract supplied in capsules containing 2.5 mg of tetrahydrocannabinol
(THC). The dose was increased every 3 days until patients reached a maximum
dose of 10 mg twice daily or experienced intolerable adverse effects. Follow-up
was performed by phone every 3 days, and patients were subjected to 3,
biweekly clinical assessments.

Following an initial treatment regimen of either placebo or cannabis,
each patient was switched to the other treatment group for the remainder
of the study.

The primary outcome measure was a functionally significant reduction
in upper limb tremor (defined as a 50% reduction of EDSS score). Secondary
outcome measures included testing a patient's performance on spiral drawings,
evaluating a timed, 9-hole pegboard test, counting the number of taps a
patient could make on calculator keys within 10 seconds, and evaluating
the numbers from an arm-ataxia rating scale.

A different doctor monitored the patients' progress, and 2 additional
assessors evaluated patient outcomes, ensuring the blinded nature of the
study. Thirteen of 14 patients completed the trial, with 1 discontinuing
for personal reasons.

The results showed little difference in primary or secondary outcome
measures in the cannabis-treated patients, other than a decrease of 3 taps
on the calculator test. However, 5 patients taking cannabis reported subjective
improvement, compared to only 1 taking placebo. No subjects improved on
all treatment measures. Adverse effects were more common with Cannador;
they included drowsiness, light-headedness, memory disturbance, dysphoria,
euphoria, increased appetite, and dry mouth. Individuals receiving placebo
experienced light-headedness, memory disturbance, and poor concentration.

Many patients thought their symptoms had improved, although, in terms
of objective measures, this wasn't the case. "It has to either be a mood
effect, and they don't mind [about their tremor symptoms] as much, or it
could be the tremor is occurring less frequently, but just as severe when
it occurs," said Dr. Fox. "Overall, these data do not support a role for
cannabis in the functional improvement of MS tremor, although given the
subjective improvement noted, it remains possible to argue for a role in
the palliation of symptoms."

A previous study, published in Nature (March 3, 2002), showed that the
use of cannabinoids (marijuana derivatives) reduced the incidence of spasticity
and tremor in mice suffering from a disease similar to MS. Other studies,
however, such as one reported in Neurology (May 14, 2002), report that
cannabinoid therapy isn't significantly effective in controlling severe
MS spasticity in humans. A largescale study involving more than 600 individuals
with MS is underway in England to determine if marijuana derivatives can
help alleviate spastic symptoms.

The NMSS Medical Advisory Board advises against cannabis as a treatment
for MS. In the United States, it is still illegal in most states for physicians
to prescribe marijuana for any condition.